Scoliosis

In an adolescent, the concern is progression during growth. Curve magnitude, skeletal maturity and growth remaining determine the risk, and monitoring is scheduled around growth rather than around symptoms.

In an adult, the curve is largely fixed unless degeneration drives new deformity. The goals shift entirely to pain, function, and where relevant respiratory capacity.

Bracing has good evidence for reducing the risk of progression to a surgical threshold in curves within a defined range during growth, and effectiveness depends heavily on hours worn per day.

Scoliosis-specific exercise approaches — three-dimensional, curve-pattern-specific programmes rather than general exercise — have reasonable and growing evidence as an adjunct. General fitness exercise does not affect curve progression, and saying otherwise raises false expectations.

Pain management, trunk and hip strengthening, postural endurance, and maintaining function. Where degenerative changes and stenosis are contributing, those are addressed directly.

Curve correction is not a realistic goal in a mature skeleton, and we say so rather than sell a programme against it.

In adolescents, curves progressing beyond a defined threshold despite bracing. In adults, progressive deformity with neurological compromise or pain that has not responded to conservative management.

Rehabilitation before and after spinal surgery meaningfully affects recovery, and prehabilitation is worth the weeks it takes.

The curve is measured in degrees from a standing X-ray, and a single measurement means little on its own — what matters is whether it is changing, and how much growth remains.

In an adolescent, remaining growth is the strongest predictor of progression, which is why monitoring intervals are set by skeletal maturity rather than by the calendar. In adults the question is different: curves progress slowly if at all, and the reason for treatment is usually pain or function rather than the angle.

In a growing spine with a curve in the moderate range, bracing reduces the likelihood of progression to the point where surgery is considered. It works by resisting progression during growth; it does not straighten an established curve.

Its effectiveness depends heavily on hours worn, which makes the practical and psychological side of wearing it a clinical issue rather than a detail. Bracing has no role once growth is complete.

General exercise is good for the back and does not change a curve. Scoliosis-specific approaches are different: they train correction of the three-dimensional deformity, breathing into the concavity, and holding corrected positions during daily activity.

The evidence base is stronger than it was and weaker than for bracing. We are straightforward about that — this work is offered for what it reliably provides, which is better trunk control, strength and postural awareness, alongside a possible effect on progression.

In adolescents the curve is usually not painful, and the concern is appearance and the fear of what will happen later. In adults, pain and reduced endurance are the reasons for coming, and they correlate poorly with the size of the curve.

Treating the number rather than the person is the common error here. The programme is aimed at what the person cannot do or cannot tolerate, and the curve is monitored alongside.